Alliance Contracting

Report

September 2016

Table of Contents

List of Abbreviations ............................................................................................................................... 1

Introduction to CollaborationNI ............................................................................................................. 2

Alliance Contracting ................................................................................................................................ 3

What is Alliance Contracting and how has it benefited Certitude? ........................................................ 4

Alliance Contracting from a Commissioner’s Perspective ...................................................................... 9

Panel Members’ insights and perspectives to Alliance Contracting ..................................................... 13

Feedback and Key Messages................................................................................................................. 17

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List of Abbreviations

CCG Clinical Commissioning Group

CO3 Chief Officers 3rd Sector

HSCB Health and Social Care Board

IPSA Integrated Personal Support Alliance

LCG Local Commissioning Group

NICON Northern Ireland Confederation of Health and Social Care

NICVA Northern Ireland Council for Voluntary Action

NISCC Northern Ireland Social Care Council

HSCB Health and Social Care Board

VCSE Voluntary, Community and Social Enterprise

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Introduction to CollaborationNI

CollaborationNI was formally launched on 30 March

2011, as a consortium between the Northern Ireland

Council for Voluntary Action (NICVA), Chief Officers 3rd

Sector (CO3) and Stellar Leadership, commissioned by

Building Change Trust. CollaborationNI provides practical

support and resources across the whole spectrum of

collaborative working to Voluntary, Community and

Social Enterprise (VCSE) sector organisations.

As part of Phase One of CollaborationNI, 553 events were held covering training, expert facilitation,

legal support sessions, coaching and policy seminars for over 4,000 individuals from 754

organisations.

Phase Two, launched in July 2014, aims to produce deeper collaborations which will influence policy

and decision makers. It will see an extension of the debate through a range of policy symposiums

which will continue to challenge our thinking, examine current approaches and focus on particular

models of collaboration, under a number of thematic areas, including health, social housing, young

people, arts, criminal justice and older people.

The aim of the policy symposiums is to challenge, inform and develop political and government

thinking about the support requirements of the VCSE sector to encourage and cultivate a culture of

effective collaboration.

The broad range of discussion will also provide an opportunity for VCSE sector leaders and

government officials to learn from good, and not so good, practices in Northern Ireland and

elsewhere in building effective collaborations, resulting in improved services and better client

outcomes.

The role of CollaborationNI is to facilitate discussions on the theme of collaboration in a way that

that delivers better outcomes through high quality, professional services.

CollaborationNI aims to help the VCSE sector to work better

together and has provided a range of different services to over

100 organisations. The support provided by CollaborationNI

can be categorised into four broad areas:

Action planning support;

Legal advice;

Expert facilitation; and

Events.

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Alliance Contracting Nora Smith, Chief Executive of CO3, opened the conference by welcoming delegates and explaining

that this is the eleventh, and final, policy symposium that has been facilitated by CollaborationNI.

This was the second event that focussed on Alliance Contracting. It built on the learning experiences

from the September 2015 seminar. The key question arising then was:

Is alliance contracting, the answer to radically change how public services are delivered

through a partnership between the Voluntary, Community & Social Enterprise (VCSE)

Sector and the Public Sector?

The first event served to introduce and explain the fundamentals of alliance contracting as a new

form of partnership working to the VCSE and public sector. The feedback from that event was

extremely positive and therefore, CollabortationNI decided to host another roundtable to examine

the concept of alliance contracting in more detail.

In addition to receiving a broad overview on this form of partnership working, the conference aimed

to specifically focus attention on the perspectives and insights from a range of commissioners in

adopting this new approach.

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What is Alliance Contracting and how has it benefited Certitude?

Certitude is a not for profit organisation providing a range of

person centred support options for 1,500 people with

learning disabilities and mental health needs in London.

Certitude is one of five organisations (2 not for profits, a local

authority, a Clinical Commissioning Group (CCG) and an NHS

Foundation Trust) that formed an alliance to offer people

with serious mental illness who currently go into long-term,

expensive hospital rehabilitation wards or registered care

homes the chance to live more independently in the

community.

Aisling began her presentation by sharing her experiences of

alliance contracting with Certitude, as part of the Lambeth

Integrated Personal Support Alliance (IPSA) over the past

two years. She was keen to share the benefit of her

experiences and to contribute the conversation.

Aisling spoke about the traditional contracting model where

a commissioner enters into a number of separate contracts

with organisations, with a strong focus on outputs. Typically,

progress is not rewarded and disputes are dealt with in a

traditional way with one, or both sides, feeling it has not

been properly implemented.

The difference with alliance

contracting is that there is

one contract between the

commissioner and a

number of providers. The

contract focuses on

outcomes based

performances, where the

objectives of the

organisations and the

commissioner are aligned,

fulfilling the needs of all

parties and addressing the

needs within the

community effectively.

Aisling pointed out that unlike traditional contract relationships, there is an expectation of trust in an

alliance contract which creates an expectation that all organisations will work together to deliver the

outputs. The whole alliance contract is about leading change and transforming services, by

Aisling Duffy Chief Executive, Certitude Aisling started her career in psychology and has spent the past 20 years working within not for profit organisations, seeking to improve opportunities for people with learning disabilities and people with mental health needs. Previously Chief Executive of Southside Partnership, Aisling led the merger of it with Support for Living to form Certitude in 2010. Aisling chairs the Alliance Leadership Team that governs the Lambeth Integrated Personalised Support Alliance.

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recognising that the current system is not working for people, outcomes are not being achieved and

peoples’ lives are not being made better by the work that is being done.

IPSA involves two VCSE providers (Certitude

and Thames Reach), a foundation NHS Trust

which provides secondary mental health

services (South London and Maudsley NHS

Foundation Trust), a commissioner (Lambeth

Clinical Commissioning Group) and the local

authority (Lambeth Council). Aisling highlighted that the partner organisations did not all wake up

one morning and decide that alliance contracting was the way forward! It was because they had an

established relationship, they recognised through regular meetings that stronger collaboration was

needed to effect real change. This was critical to the success of their alliance that they already had

very strong and established relationships and that all partners had a good understanding of each

other and the problems that they were trying to address. There existed a relationship of respect and

understanding of one another.

Aisling said that an important aspect of the success of their alliance was that they had a visionary

commissioner (she made the point of saying that she wasn’t just saying that because he was sitting

beside her!) who genuinely wanted to find new ways of working and who passionately wanted to

make a difference. She pointed out that in her experience that this is the exception, not the norm.

As well as wanting to change outcomes there were also enormous financial pressures facing services

in Lambeth. Eighteen months previous, when IPSA was being set up, the target saving was in the

region of 20-25%, meaning they were attempting to transform how services were being delivered

and provide better outcomes for people, in the context of simultaneously having to make significant

savings.

For Aisling, IPSA is very much focussed around supporting system change. It is concerned with

looking at how they can better integrate secondary care, VCSE sector services and social care to

deliver the outcomes that matter to people. By using a strong evidence base to focus on the

rehabilitation of people with complex mental health needs they were able to successfully make the

case for a radically new approach, whilst at the same time addressing the financial situation.

Aisling turned her attention to the ongoing work of IPSA and highlighted the two driving objectives

which ensure that they can deliver on their ‘Big 3’ outcomes for people with severe and enduring

mental health and complex life issues:

“Big 3” outcomes

To support people to:

1. Recover and stay well experiencing improved

- Quality of life.

- Physical and mental health.

2. Make their own choices & achieve personal goals, experiencing increased:

- Self-determination and autonomy.

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3. Participate on an equal footing in daily life specifically:

- To ‘connect’ with e.g. family, friends & neighbours.

- To ‘give’ in the community e.g. community activities, volunteering, peer support.

- To ‘be included’ especially in relation to education, employment, adequate income and stable

housing.

- To ‘participate’ on an equal footing with others with reduced stigma & discrimination e.g. in

access to mainstream services, housing, education and employment.

Aisling also took some time to explain some of the specific characteristics of their alliance

agreement. This helps to ensure that all objectives are collaboratively being worked on and do not

become the responsibility of just one partner. The principles that drive the alliance are set out in

their contracting arrangement and agreed by all partners, influencing everything that they do; their

interactions, their delivery and how they all hold each other accountable in delivering their change

programme. Aisling conceded that this can sound twee but it is about ensuring that everything they

do is about delivering outcomes and improving the services for people in the local community. The

principles at the heart of their alliance are:

• Co-production in everything they do;

• Service user at the heart;

• Honesty;

• Best for service decision making for service improvement and development decisions;

• Empathy and understanding of each other;

• Openness through open book reporting and accounting;

• Transparency through publication of our outcomes and performance; and

• Unanimous decision making.

Aisling subsequently explained the benefits of a VCSE sector organisation, such as Certitude, being

part of an alliance contract. She spoke about how, at the outset of this process, the board of

Certitude were a combination of sceptical, anxious and concerned about the prospect of entering

into an alliance contract. What drove their desire going forward was the absolute commitment to

being part of making system change that could make a massive difference to the people they were

supporting. Whilst Certitude had been supporting people in Lambeth for 25 years they knew their

clients needed more. They didn’t just want to work in silos, criticising others; they wanted to do

things differently. Aisling highlighted that there was already huge alignment between the vision and

values of all members within the Alliance. Without this shared vision alliance contracting would not

have worked for them. For the alliance to be a success they had to be absolutely confident that the

vision of partners matched the vision of Certitude.

Aisling pointed out that one of the most appealing aspects of alliance contracting is that it allows

each organisation to retain their own identity and status, without having to create a new legal entity.

The structuring of risk management was also important as everyone signed up to the same

outcomes, with an associated gainshare/ painshare linked to the achievement of their agreed

outcomes. In essence this means that if outcomes are achieved all partners win (there is a financial

gain) but if outcomes are not achieved all partners face a pain (a financial penalty). The fact that all

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partners benefit, or suffer, means that everyone is driven towards achieving the outcomes. Each

provider is allocated a different budget against the parts of the contract that they have to deliver on,

ensuring that painshare/ gainshare is proportionate to income, which is an important part of

mitigating risk, especially for smaller VCSE organisations.

Eighteen months into the contract the results have been extremely positive and are making a real

impact on the lives of people in Lambeth. Some of the highlights include:

• 60% reduction in admission rates to inpatient rehab wards; • New integrated team of VCSE organisations, social workers, nurses, occupational therapists

and consultant psychiatrists intensively supporting people at home; • Flexible Medication Management Support service – VCSE led; • In reach and outreach; • Residential care use reduced by 67% and discharges increased by 30%; • A 7-person intensive support rehabilitation step down and 9 new studio apartments within a

peer support hub; • Brokerage service accessing independent flats; • New advice surgeries to support change; and • On course for circa 20% savings by year 2.

In addition to these practical successes, there have also been significant learnings. They have learned

that relationships are absolutely critical, and that if you do not establish them effectively from the

outset, when things become difficult, as they often can, there is nothing to fall back on. This is

central when the partners negotiate the ‘concept’ of redesigning services. In reality organisations

tend to redesign services for their own benefit, so everything they did had to be ‘people-centred’.

She also recognised that people in different organisations involved in partnerships will have different

ways of working and will face different challenges. This means that it is essential that partners are

respected, their concerns are heard and solutions are found through a partnership approach. Aisling

suggested that understanding how other organisations operate, allows you to adjust your

expectations on how they will deliver services. For example, a member of staff from a VCSE

organisation, who has never worked closely with a statutory organisation in the past, may not realise

that due to bureaucracy and procedure sometimes it takes the statutory organisation a long time to

sign off on a decision. Through understanding these cultural differences, the partners develop a

sound understanding of how the alliance will work in practice.

Aisling made the particular point that they had great difficulty in discovering how and where money

was being spent before the alliance contract, at the point when they were trying to finalise the

contracting arrangements. It is important to know how the money is being spent so that all partners

can understand the scenario that they are trying to change. If this has not been done from the

outset it may result in unnecessary difficulties, slowing down the process.

Another key learning that Aisling made reference to was the need for belief in what you are doing.

At times of doubt, when things are not going entirely as they are supposed to, that is the time for

you to remember why you started this journey and what you are trying to achieve. All of the

partners faced challenges and everyone had to overcome some form of difficulty as they were all

working differently.

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Aisling highlighted two service users, Michael and Chad, who had experienced first-hand the work of

the partnership and who had seen a real improvement to their lives.

Aisling concluded her presentation by reminding everyone that ultimately everything that they were

doing was about improving peoples’ lives. She highlighted examples of life changing work that the

partnership was involved with and the huge impact that these new working arrangements had on

their quality of life.

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Alliance Contracting from a Commissioner’s Perspective

NHS Lambeth Clinical Commissioning Group (CCG) is responsible for

commissioning healthcare services for the people who live and work in the

London borough of Lambeth. The group of 47 GP practices in Lambeth work

together with their partners in the local NHS - pharmacists, dentists,

hospitals and mental health providers, Lambeth Council and local

community groups, to improve health and wellbeing, reduce health

inequalities, and ensure everyone has equal access to healthcare services.

They are responsible for spending £430m each year on hospital and

community health services for patients, in a way which ensures the most

effective services are available.

Denis began by telling delegates that he intended to talk about the

experience of Lambeth in providing adult mental health services to people

with severe and enduring mental health problems over the past decade.

He explained his role working for Lambeth CCG, which holds the commissioning budget for the area,

and how he leads on adult mental health commissioning for the Lambeth local authority area.

Lambeth is one of 32 London boroughs, which has undergone massive population change in the past

decade but still remains one of the most ethnically diverse, densely populated areas in London. It

has one the highest rate of psychosis in western Europe.

Denis O’Rourke Assistant Director of Integrated Commissioning in Mental Health, Lambeth NHS Denis is the Assistant Director, Integrated Commissioning in Mental Health for NHS Lambeth CCG. Denis deals specifically with strategic aims of The Collaborative and the Collaborative Commissioning framework.

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The transformational journey in Lambeth started approximately six years ago, when a number of the

local mental health organisations got together and decided that the current system, which was

dominated by the statutory sector had failed to give a powerful voice to service users. It required a

radical overhaul. As commissioners they believed that their role was to enable, not dictate, the

discussion. Very often discussions around adult mental health centred on beds, and in Lambeth the

70 beds that they funded had a 120% occupancy rate. Denis made the point that 80% of patients in

beds are known to service providers and that to really make a difference they needed to support

them more effectively to reduce the likelihood of them ever needing a bed.

In order to address these issues, they

formed the Lambeth Living Well

Collaborative, which brought together a

wide range of mental health experts,

clinicians and service users. They made the

explicit decision not to have these meetings

at the local NHS offices or in Lambeth

Council headquarters, but met monthly for breakfast so that they could have conversations about

change and better outcomes. Out of the meetings came a shared vision for the way they wanted to

do things and how they would start to work differently. Denis pointed out that they came to a

shared understanding that the problems around delivering mental health services all stemmed from

how they engaged with people. People treated, as patients with problems rather than as the fully

rounded, complex individuals that

they were. They spent

considerable time talking about co-

production which asked people

how they could help them retake

control of their own lives again,

rather than simply treating the

symptoms, not the causes, of their

problems.

Denis spoke about how they wanted to address ‘3 big outcomes,’ which were:

1. Recover and stay well,

2. Make their own choices & achieve personal goals, and

3. Participate on an equal footing in daily life.

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They also undertook an audit of where money was

being spent and they came to the realisation that

the bulk of spending was tied up in services that

people could not access unless they had reached

crisis point. This realisation was incredibly

important and there was general consensus that

they had to turn this model on its head and

structure the system in a way that would enable

support to be accessible at an earlier stage,

hopefully ensuring that the crisis point was never

reached.

Denis then spoke about how, four years previous, the work of the Lambeth Living Well Collaborative

began to evolve into IPSA. They began to develop their ‘front door’ approach to people with mental

health problems. This brought more focus onto their ‘3 big outcomes’ and allowed people to have

rounded conversations, challenging the idea that diagnosis was all that mattered. As part of a pilot

scheme they also identified a dozen patients with extremely complex mental health needs and

agreed a joined-up support plan for them. They identified similar patterns in these patients, crisis

after crisis, multiple admissions to hospital, lack of any basic conversation about their needs and this

allowed them to design a new ‘front end’ system which has changed how patients are helped.

Denis spoke about how prior to November 2013, the local health trust was receiving 120 GP referrals

each month to the community mental health teams, of which only 20/25 were accepted. By

speaking to GPs they discovered that once they referred a patient to the community mental health

team, they would not hear whether they had been assessed, let alone treated. Most people who did

receive treatment only did so when they were admitted to hospital; clearly the system was not

delivering for people. When the Living Well Hub opened in November 2013, it began to receive

120/130 introductions each month (now over 400 per month) whilst the number of people accepted

by referral to the community mental health team has remained in the 20s. Denis stressed that this is

significant as more people are receiving low-level support, at a time when social care is facing

enormous financial pressure. He pointed out that, faced with these budget pressures, the

traditional, cost-cutting approach is to increase eligibility criteria, in order to limit the number of

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people who can receive care; they did the exact opposite. They did so in the knowledge that most

people only wanted to access services every now and then. When a conversation was not sufficient,

they would signpost patients to other relevant forms of support. One of the key outworkings from

the hub is that the number of in-patient stays for adults with severe mental problems has decreased,

meaning clinicians can now spend more contact time with clients. People who had previously been

waiting months for a referral have now seen waiting times decrease and they are able to receive

care much quicker. Denis spoke about how they also work closely with housing and employment

services, partially to help reduce sanctions on patients who had missed appointments as a result of

their condition.

In terms of funding IPSA, Denis spoke about how a £12m pooled budget had been allocated towards

the alliance, with £7m being directed towards the NHS (for patient rehab) and £5m to patients in

residential care. Denis outlined how he wanted to see the role of commissioner adapt and change to

become that of a facilitator, moving away from the big-boss, command and control model, given the

challenges that they are facing. He identified ten ‘takeaways’ which he felt should form the thinking

for future working:

1. Commissioners should be facilitators and enablers – letting go and supporting a whole system

conversation.

2. Believe in people and their assets - it’s not about ‘fixing’ people.

3. It’s not just about care – housing, work and community are all parts of the solutions.

4. Design led thinking – prototyping, use of stories etc.

5. Changing money flows and investing in good data is critical to inform decision making.

6. Cultures can be changed by working together.

7. Decision making best for outcomes.

8. Old to new ways of working is challenging with lots of people and systems keen to stop us!

9. Longer term contracts support and incentivise change.

10. It’s all about relationships which take longer than you think!

Whilst wanting to address the successes of IPSA, Denis also spoke about the difficulties which they

continue to face in Lambeth. He discussed how they face increasing demands and reduced

resources; an increasingly complex, bureaucratic system which is highly inefficient and is not

outcome focussed; and widespread societal inequalities.

Before concluding his remarks, Denis took a few moments to discuss where they hope to go over the

next few years, and key to this is the idea of a whole system alliance. This would involve pooling up

to £66m into one alliance contract which may be the only way to deliver services in the future as

they face further restrictions on their budgets. The whole system alliance will focus on early

intervention and really challenge the old models of care which are still being used. A big part of this

new alliance will be about driving change across the health system and realigning thinking between a

number of different agencies. With many systems having been designed over 30 years ago there are

many opportunities, through the use of new technologies and fresh thinking, to radically redesign

service delivery.

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Panel Members’ insights and perspectives to Alliance Contracting

Following on from the keynote presentations a panel of local practitioners

gave their perspective on alliance contracts. Below is a summary on their

remarks and the question and answer session which followed.

Colum Conway, Chief Executive of Northern Ireland Social Care Council (NISCC) Colum spoke about how he does not have a commissioning or

procurement relationship with anyone but has a regional, strategic view

of social care across NI, how it is being delivered and the impact it has.

Social care, as a market in NI, has a value of over £500M and as a result of

demographics it is a growing market, with a requirement for more

services. There are almost 500 different employers, employing over

30,000 people, across NI, with forecasts indicating that this workforce will

have to increase by at least 18% by 2025.

Colum spoke about how the current model is a traditional procurement model with straight vertical

lines between commissioners and providers, information across the sector is at a premium. The

current model is not sustainable; we need to consider different models of social care in the future on

the same basis as has been done in the past. The current model is heavily focussed on risk

management, governance and inputs, and not so much on outcomes of service delivery and

responding to need, which is something that must change as we go forward.

Colum also spoke about how he sees alliance contracting as a step on a journey which is about

opening up more conversations and bringing about a culture shift. Once you start on this particular

journey you can then start to examine the logistics around procurement and contracting, devising

new ways to make them work. He also saw the importance of a commitment to collaboration at the

outset of the journey, which made him question whether a similar commitment to collaboration

currently exists in the system in Northern Ireland.

Dr Sloan Harper, Director of Integrated Care, Health and Social Care Board Sloan spoke about the change which is currently happening in social care, with a move from service

provision being primarily delivered by the statutory sector, to being delivered more closely with the

VCSE sector.

Sloan spoke about the role of Integrated Care Partnerships (ICPs) which he feels are similar to the

work that is being undertaken in Lambeth. He sees ICPs as an alliancing network between a number

of service providers, VCSE organisations and commissioners and is hopeful about the role that local

government community planning will play in the development of ICPs over the next few years.

He made the observation that during the design of ICPs they worked closely with practitioners from

north west London and learned a lot from their experiences. He welcomed the fact that, in Northern

Colum Conway Chief Executive of Northern Ireland Social Care Council (NISCC) Iain Deboys Commissioning Lead, Health and Social Care Board (HCB) Dr Sloan Harper Director of Integrated Care, Health and Social Care Board Heather Moorehead Director, NI Confederation of Health and Social Care (NICON)

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Ireland, we have the advantage of having an integrated health and social care system, as opposed to

the English model which splits health and social care.

Within ICPs, GPs sit down with representatives from the VCSE sector, medical practitioners and

social workers, with a focus on improving long-term conditions in elder care. As part of this

conversation they learned from patients and service users that they are more interested in

improving their experience when they are in hospital, rather than where the hospital is located,

which helped feed into the Transforming Your Care review on the provision of health and social care

in Northern Ireland.

In concluding his introductory remarks, Sloan made the point that whilst ICPs do not have a budget,

which are held by the LCGs, they have entered into a number of projects, which effectively operate

as alliance contracts.

Iain Deboys, Commissioning Lead, NI Health and Social Care Board (HCB) Iain began by agreeing with Colum that we have been on a journey over the past few years and that

he believes that alliance contracting will work best when there is a partnership of equals between

providers, with no single, dominant provider.

Iain spoke about the need for time to be spent developing relationships, and a culture of equality,

between Health Trusts and VCSE organisations. To illustrate this point, he suggested that each year,

when Trusts are asked to find savings, their first suggestion is often to reduce the funding to VCSE

organisations. He made the point that this is not a good place to start and shows just how far we

have to travel to develop equal relationships.

Whilst he could see the benefits of alliance contracting he spoke about the steps taken to achieve

closer collaborative working that have already been implemented. Examples include Memorandums

of Understanding, consortiums, federations, partnerships and mergers. He suggested that the

ambition behind a whole system approach is admirable, and despite having similar sized budgets for

mental health provision, he feels it is unlikely that Belfast would adopt the Lambeth model in one

step, but it is important that we are on that journey.

He gave the example to note of Belfast in primary care talking therapies, which recognise the issue

of people not being offered the opportunity for recovery in the early stages. Instead of GPs referring

people for secondary care, and being bounced back and forward through the system, they worked

with the ICPs to design a pathway where GPs refer patients into an integrated hub, which is a formal

consortium of VCSE organisations, who offer evidence based therapies. A similar Hub is being

developed for Chronic Disease Prevention which will move from relying on signposting by GPs to a

more formal coordination of VCSE preventative services.

Heather Moorehead, Director, NI Confederation of Health and Social Care (NICON) Heather began her remarks by saying how it was positive to hear from people in the public sector

who not only talk about new ideas, but who are actually implementing them. She made the point

that whilst conversations like this have been going on for the past 20 years, this is the perfect time

for action, as the new Programme for Government is supposed to be about outcomes, so everyone

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will be working towards an outcomes framework. Heather spoke about the opportunities that will

emerge through community planning and how there will be opportunities for more joined-up

services. She made the point that together community planning and an outcomes focused

Programme for Government have the potential to embrace new business models and radically

change how services are delivered. There is now a real opportunity for better linkages between the

public, private and VCSE sectors, and between local and central government, with everyone focused

on delivering better services for the people that use them.

Heather concluded that whilst it is easy to talk about making changes to the system, in reality things

are much harder. Heather finished by talking about the number of amazing people out there who

are doing everything that they can to bring about system change, against the backdrop of large

budget cuts. Fundamentally the only way to develop better health and social care is by devising new

ways to deliver services.

Question and Answer Session

Q. We have seen some steps in Northern Ireland towards closer working relationships between

the public sector and VCSE organisations but what advice is there for VCSE organisations who

want to be part of future solutions?

Whilst the VCSE sector has to get its act together, there is an onus on the statutory sector to do

more to reach out. Very often it is the VCSE sector that has fresh ideas but the statutory sector

is not prepared to listen or sees obstacles when it should be seeing opportunities.

Service provision should rest within the community and be delivered locally. At present there is

a failure to leverage community assets. There is too much emphasis within service delivery of

looking for economies of scale as the only way to manage large amounts of money. We need to

do more to look at the value which exists within communities and the services they can deliver

which, for example, can keep older people in their homes rather than sending them to

residential accommodation. We also need to challenge how we deal with procurement issues

which can disadvantage local, community based groups.

VCSE organisations can do a lot by connecting with each other, as very often larger VCSE

organisations work alone. This helps the public sector manage their relationship with VCSE

organisations and gives the organisations greater say. VCSE organisations also need to connect

with their communities and should work with them to lobby politicians and ask them what they

are doing to create a level playing field between the VCSE organisations and the statutory

sector. VCSE sector organisations should use this opportunity to explain to politicians what is

wrong with the system and the role they can play in making things work better.

Q. Are we ready for this form of partnership working and is there an appetite for closer,

collaborative working?

We are on a journey and we are all at different stages on that journey. There are different

issues and conditions but to get us ready we need to continue to build relationships within, and

between, sectors.

There is amazing work going on and we need to go to where there is amazing leadership and

support it. We all know that we are not spending money well enough and, as we see more and

more examples of how some people do things well, there will be pressure brought on those

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who are not delivering. We need more tools as we seem to be stuck in traditional processes- we

know where we want to go but at present we don’t seem to be able to get there.

This is about leading change and it is up to all of us to decide what role we are going to play in

the change that we all know needs to happen. We are all dissatisfied with the current system

but we need to decide how we want to move forward together. The challenge we all face when

we leave here is not to say ‘that was a very interesting conversation but who is going to drive

this forward?’ instead we all need to commit to driving this forward.

Q. At the moment there are countless strategies which overlap and interact with each other.

When you are devising new methods of working and delivering and services how do you fit in with

these existing strategies and do they help or hinder the process?

There is a constant tension between trying to be new and innovative and fitting in with existing

governance guidelines. Very often government is slow to come around to new ways of thinking

and they can often be reluctant to embrace new ideas. There is a need to be constantly asking

them what it is they want to achieve, and to have an evidence base that shows that new

methods of working actually deliver.

Policy is what you make of it- often it is not a barrier. Commissioning and procurement are

often tied up in government strategies and this can make it difficult for fresh thinking to feed

into this. That is why it is important to pick your timing and to decide when and where to test

out new ways of working. Collaboration is only collaboration when there is accountability and

everyone involved has to do more than just turn up- they have to deliver and government has a

role to ensure that they spend money in a way which is accountable.

Q. There are many drivers towards collaboration but what support was there in Lambeth for IPSA

and how important was it?

We had support from LH Alliances (Linda Hutchinson spoke at the CollaborationNI event in

September 2015 on her role supporting IPSA) in order to facilitate the collaboration coming

together and to develop the outcomes and commercial frameworks. This assisted them in

creating a partnership of equals and allowed them all to access the risk (and potential gains)

involved in what they were trying to do.

LH Alliances enabled them to set up shadow governance arrangements well before they started

operating the contract. Again this allowed them to develop their relationships and plan the way

forward.

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Feedback and Key Messages Following the conclusion of the presentations

delegates were asked to complete a feedback

form to capture the key messages related to

the potential benefits of co-design and co-

production. The key messages that were

identified from the feedback forms were as

follows:

To government

We need government to:

Understand the value of alliance contracting and the opportunities that it can create.

Do more to encourage alliance contracting and make it a viable option for VCSE organisations in

Northern Ireland.

Recognise the importance of VCSE organisations and the significant contribution they make.

Commit to proper collaboration whilst at the same time review the commissioning process so

that value-added and social investment is given a proper weighting.

To politicians

We need politicians to:

Get serious about collaboration and commit genuine support and funding, rather than merely

pay lip service to the notion of collaboration.

Adopt an outcomes based approach to their decision making, to ensure that they deliver the

most for the greatest number of people, rather than focussing on their own narrow interests.

To the VCSE sector

The VCSE sector needs to:

Be willing to look beyond their own organisation and ensure that the work they do benefits as

many people as possible.

Understand that they are not in competition with each other and should understand that by

pooling their resources all sides can benefit.

Ensure the commissioning and procurement process is not seen as a barrier to VCSE

organisations but as an opportunity.

Be willing to share learning with each other so everyone can benefit.

To funders

Funders need to:

Provide the necessary resources- both financial and organisational- to facilitate collaboration.

Engage at an early stage with organisations who are considering collaboration so that they can

better understand the type of support that is necessary and the difficulties that may arise

during the process.

Provide a strategic drive to support genuine collaboration and not see it purely as a cost cutting

exercise.

18

94% of respondents said that the overall input was

either Excellent or Very Good. 100% of respondents

Strongly Agreed or Agreed that they found the input

useful and 100% of respondents Strongly Agreed or

Agreed that the input increased their knowledge.

Delegates were asked to reflect on the event and

below are some of their comments.

“Such a worthwhile conversation. Let’s keep talking to each other.”

“The input from the speakers and panel was very insightful and provided

evidence of what is achievable through collaborative working.”

“Collaboration is key to better health and social care outcomes. ICPs are the

vehicle to build and promote the relationships and cultural change and drive

this collaboration.”

“Fantastic event, great speakers and panelists, all expertly guided by Ricky.

An amazing learning and sharing experience.”